Purpose:The liver is susceptible to adverse effects from radiation therapy (RT) and systemic therapy (ST) for breast cancer, given its anatomical proximity. Thus, we evaluated hepatotoxicity after RT and ST for breast cancer.Methods:This multicenter retrospective study included breast cancer patients treated with RT in 2021 and underwent a liver function test (LFT) before and after RT. Patients with bilateral breast cancer or a history of thoracic or abdominal RT and liver disease were excluded. Changes in Common Terminology Criteria for Adverse Events (CTCAE) grading of liver enzyme elevation (LEE) of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) and its associations with Dose-volume histogram (DVH) parameters and other clinical factors were analyzed.Results:In total, 529 patients were included in the analysis. Median values of mean liver dose, V5Gy, V10Gy, and V20Gy dose to the liver were 1.37 Gy, 4.3%, 2.1%, and 0.9%, respectively. In the post-RT LFT, 6 (1.1%), 9 (1.7%), and 25 (4.7%) patients showed CTCAE grade elevation of AST, ALT and ALP, respectively, with most cases being grade 1. Three patients (0.6%) met the diagnostic criteria for radiation-induced liver disease (RILD). In multivariate logistic regressions including various DVH parameters, neoadjuvant therapy was associated with LEE.Conclusions:The incidences of LEE and RILD after multimodal therapy for breast cancer were limited, suggesting that RT and ST can be considered safe in terms of hepatotoxicity. Nevertheless, caution in treating patients who underwent neoadjuvant therapy, especially to those with underlying liver disease, might help minimize LEE.
目的：鉴于肝脏与乳腺的解剖位置邻近，乳腺癌放疗（RT）及全身性治疗（ST）可能对其产生不良影响。为此，本研究评估了乳腺癌患者接受RT与ST后的肝毒性反应。 方法：本多中心回顾性研究纳入了2021年接受放疗并在治疗前后完成肝功能检测的乳腺癌患者。排除标准包括双侧乳腺癌、既往胸腹部放疗史及肝脏疾病史。研究分析了天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）及碱性磷酸酶（ALP）的肝酶升高（LEE）在不良事件通用术语标准（CTCAE）分级中的变化，并探讨其与剂量体积直方图（DVH）参数及其他临床因素的相关性。 结果：共529例患者纳入分析。肝脏平均剂量、V5Gy、V10Gy及V20Gy的中位值分别为1.37 Gy、4.3%、2.1%和0.9%。放疗后肝功能检测显示，分别有6例（1.1%）、9例（1.7%）和25例（4.7%）患者出现AST、ALT和ALP的CTCAE分级升高，其中绝大多数为1级。3例患者（0.6%）符合放射性肝病（RILD）诊断标准。在多因素逻辑回归分析中，新辅助治疗与肝酶升高显著相关。 结论：乳腺癌多模式治疗后肝酶升高及放射性肝病的发生率较低，提示放疗与全身性治疗在肝毒性方面具有安全性。然而，对于接受新辅助治疗的患者，尤其合并基础肝病者，仍需谨慎处理以尽可能降低肝酶升高风险。
Comprehensive Evaluation of Hepatotoxicity Following Radiation Therapy in Breast Cancer Patients
肿瘤(癌症)患者之家